Provider Demographics
NPI:1114051901
Name:HARVARD PARK OPTICAL
Entity Type:Organization
Organization Name:HARVARD PARK OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-777-7091
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7007
Mailing Address - Country:US
Mailing Address - Phone:303-777-7091
Mailing Address - Fax:303-777-6402
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7007
Practice Address - Country:US
Practice Address - Phone:303-777-7091
Practice Address - Fax:303-777-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0738860001Medicare NSC